Electronic Pre-Transfusion Check at the Bedside: Experience in a University Hospital

of the guidelines Background: JSTMCT Working Party on hemovigilance and safety management of blood transfusion issued the first version of guidelines for the electronic pre-transfusion check for blood administration at the bedside [33]. The current guidelines cover issues concerning: a) Pre-transfusion check procedures at the bedside b) Requirements for the electronic pre-transfusion check at the bedside c) Pre-transfusion check procedure at the bedside for a conscious patient d) Pre-transfusion check procedure at the bedside for an unconscious patient or child e) Pre-issuing check procedure at the transfusion service and f) Monitoring of the bedside use of the issued blood components. When an EIS is implemented in a hospital, the pre-transfusion check procedures at the bedside may involve one or two healthcare professionals. When one individual carries out the pretransfusion check procedure using an EIS, it seems to be plausible. However, if electronic pre-transfusion check at the bedside fails due to human error [20], one-person bedside checking without new technology may present a higher risk of mistransfusion than a standard two-person double-check, although the number of people required checking the identity of the patient and blood unit at the bedside is controversial [34]. Japan Guidelines recommended a standard two-person visual and verbal doublecheck for pre-transfusion check procedure at the bedside. In addition, the recent BCSH Guidelines stated that “the use of a bedside blood tracking system does not replace the role of the well trained and competency assessed clinician who administers blood components” [35]. The current guidelines do not positively recommend a one-person pre-transfusion check at the bedside even if using an EIS. Thus, the current guidelines recommend that the electronic pre-transfusion check procedures at the bedside should be basically carried out by ‘two-person’, of whom one should be the transfusionist and the other should be the second checker. The second checker may not be limited to healthcare professionals, such as the patient. When the patient is conscious the transfusionist (nurse or doctor) together with the patient, conducts the pre-transfusion check procedures at the bedside using an EIS. When the patient is unconscious or child, two nurses (or a doctor/nurse pair) conduct the pre-transfusion check procedures as well. In this case, another healthcare professional, such as the staff member of the transfusion service who delivered the issued blood component into the clinical area, instead of the patient, may be available for the second checker. Pre-transfusion check procedure at the bedside for a conscious patient: This case may be a common situation in most hospitals. The entire process of the electronic pre-transfusion check procedures for a conscious patient should be conducted basically by one nurse (or doctor), together with the patient and Electronic Pre-Transfusion Check at the Bedside: Experience in a University Hospital 6/7 Copyright: ©2017 Ohsaka Citation: Ohsaka A (2017) Electronic Pre-Transfusion Check at the Bedside: Experience in a University Hospital. Hematol Transfus Int J 4(3): 00087. DOI: 10.15406/htij.2017.04.00087 carried out at the bedside using an EIS. The role of the patient is expected to act as the second checker. Thus, another healthcare professional may also be available. The transfusionist: A. Asks to the patient to state his/her full name and date of birth. B. Checks the clerical information, together with the patient, under reviewing both the blood unit and the compatibility report form. C. Scans sequentially the bar codes of his/her own identification badge, the patient’s wristband and the blood unit using the hand-held device. D. Verifies the displaying data on the hand-held device, together with the patient, where the bar codes match or not between the wristband and the blood unit. E. Initiates ‘immediately’ blood administration if the hand-held device displays ‘OK’. Pre-transfusion check procedure at the bedside for an unconscious patient or child: This case may be a common situation in the intensive care unit, emergency rooms and on inpatient wards for children. The entire process of the electronic pre-transfusion check procedures for an unconscious patient or child should be conducted basically by two nurses (or a doctor/ nurse pair) and carried out at the bedside using an EIS. If two nurses conduct the electronic pre-transfusion check procedures at the bedside, one should act as the transfusionist and the other as the second checker. In the case of a doctor/nurse pair, a nurse may act as the transfusionist and a doctor as the second checker. The second checker may also be available for another healthcare professional. The transfusionist: a. Checks the patient’s full name and date of birth, together with the second checker, under reviewing the patient’s wristband. b. Checks the clerical information, together with the second checker, under reviewing both the blood unit and the compatibility report form. c. Scans sequentially the bar codes of his/her own identification badge, the patient’s wristband and the blood unit using the hand-held device. d. Verifies the displaying data on the hand-held device, together with the second checker, where the bar codes match or not between the wristband and the blood unit. e. Initiates ‘immediately’ blood administration if the hand-held device displays ‘OK’. In regards to the detailed descriptions, please read the original manuscript [33]. The first version of guidelines for the electronic pre-transfusion check for blood administration at the bedside has been established, being appropriate for the clinical situation in Japan, because approximately 90% of Japanese teaching hospitals have implemented an EIS for pre-transfusion check procedures. Prevalence of an EIS in Japan The Association of Transfusion Division of University Hospitals (ATDUH, 2014, chairman Teruhisa Fujii, Hiroshima University Hospital, Hiroshima, Japan) made inquiries using questionnaires involving a small cohort of the transfusion service of university hospitals in Japan (n=91). The members of ATDUH are teaching hospitals and representatives of regions distributed widely in Japan and also those of JSTMCT. All the transfusion service in university hospitals was registered. The questions referred to the transfusion practices and use of IT systems, including a transfusion management system and a bar code-based EIS: vendor of the system, name of application for the system, date of initiation of the system and compliance of the electronic pre-transfusion check at the bedside. Of the questionnaires sent to 91 transfusion services, 90 (99%) were returned fully completed. Finally, 81 (90%) transfusion services answered that the pre-transfusion check procedures have been carried out using a bar code-based EIS. At present, the overall prevalence rate of an EIS for pre-transfusion check procedures at the bedside in Japanese university hospitals is 90%. Further studies including a nationwide survey are needed to explore the prevalence of an EIS in Japan.